Provider Demographics
NPI:1619397494
Name:CLAY HEALTH CARE CENTER, LLC
Entity Type:Organization
Organization Name:CLAY HEALTH CARE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY JO
Authorized Official - Middle Name:
Authorized Official - Last Name:PAINTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-344-1623
Mailing Address - Street 1:PO BOX 532
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25322-0532
Mailing Address - Country:US
Mailing Address - Phone:304-344-1623
Mailing Address - Fax:304-344-5853
Practice Address - Street 1:240 CAPITOL ST
Practice Address - Street 2:SUITE 500
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-2221
Practice Address - Country:US
Practice Address - Phone:304-344-1623
Practice Address - Fax:304-344-5853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-21
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV137314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV515142Medicare Oscar/Certification